In the Driver's Seat: Chuck Huss - Rehabilitation Specialist part 2 Description of graphical content is included between Description Start and Description End. Transcript Start [Music] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. [Music face out] Fade to black. [ Music ] [ Title start: ] Description Start: Title: In the Driver's Seat A Conversation with Chuck Huss Consideration for Students: The Decision to Drive continued Description End: [ Title start: ] Description Start: Title: In the Driver's Seat Chuck Huss Coordinator of West Virginia Bioptic Driving Program at WV Division of Rehabilitation Services Description End: [Title end:] Chuck Huss: With head-born telescopes, you can get a 2.2 power Designs for Vision, what they call BIO II Galilean system that are very miniature in size. Offers about a 12-degree field of view. But cosmetically, they're very more acceptable to younger age groups. But for an older adult. Okay? The same power of scope, with a telescope that protrudes a little bit further out, and the difference in field is maybe one degree. Okay? Cosmetically there's a difference. But with a hand-held system, again... you know, you're going to have lower powers. Okay? But you're not going to have the input. And with a... a system that's used head-born, remember you can walk with it. Okay? You can dip down to it at an APS signal real quickly, and get it just like that. Okay? It's a time issue, in many instances. This rapid non-manual interchange, Cindy, is one of the reasons that, oftentimes, individuals prefer a head-born system over a head- over a hand-held system. Now, a lot of it deals with maturity, too. Okay? The individual has to be responsible for that device. When you're talking about a device that runs $1,200 to $2,000, you can't afford to misplace that. And a lot of times, younger kids will misplace that hand-held telescope. They'll forget where they used it last. And there you're talking the difference between $100 and $200, versus a device that's 10 times that amount. Okay? So there's a time and place. Will individuals, of all ages, benefit from head-born system? Yes, there is. As they grow older and as their body features change, yes, you may have to replace a temple, or a nose bridge, or something like that. But... I think the-- the more expensive systems... the individuals may actually be a little bit more receptive, but not to say that hand-held systems play an important role. I think they do. Okay? And I still continue to endorse it. Cindy Bachofer: I wore a bioptic for a couple of years, and am a good telescope user. And I have greater comfort with the telescope, the field of view and my focusing ability. Huss: On a hand held? Bachofer: Yes. On a hand held. And reinforcing with students the advantages of building your skill with that device, and then applying it with a bioptic. Where I think, in the driving situation especially, it's a much more demanding task that the hand-held telescope supports. Huss: Yep. Remember, too, that when we talk about driving, we're talking about a complex task. Driving involves physical skills, mental skills, and social driving skills, precisely timed and executed. Okay? And... and again, I don't want to underestimate the benefit of telescopic magnification. But I also want to emphasize the fact that there's more to a formalized program, than just device training. Bachofer: Sure. Absolutely. Huss: Okay? And that- that's the reason why even before a young child gets a hand-held telescope in their hand. Okay? They got to know what they're looking for, right? They need to know where to look. Where that object is supposed to be. Okay? And why they're looking at it. Okay? They have to know that. For instance, when they spot a stop sign. Well, why is it important that I know a stop sign? Well, you need to know is it a two-way stop, or a four-way stop? Or an all-way stop? Okay? This sort of thing. So, that's where parents can now teach individuals that after they realize they can see things, whether it's with a hand-held, or a head-born system, now why is it important? And that's where that little bit of time that a parent can pull off to the side of the road, and say this is why it's important. And then their son or daughter will say "Oh, I'm getting a better idea what driving is all about." Bachofer: And I think you brought up previously the magnification, the re-estimating. Huss: Yes. Bachofer: What looks close is not as close. Huss: Yes. Bachofer: And the more experience you have, of getting used to that recalculating, you can do that through any of your instances with a hand-held telescope, as well. Huss: Yep. Yep. Bachofer: Driving is a demanding task. For example, one of the things that always seemed scary in traffic, is when you've got cars on either side of you, gauging that distance of staying a safe distance, and side mirrors seem only so helpful. Bioptic doesn't really help with that. For example, how do you use your visual skills to manage that task? Huss: Okay? Lane maintenance is actually done with your peripheral vision, and not your central vision. In fact, if you attempt to maintain a lane position with your central vision, you will actually cross what we call your longitudinal pavement markers, whether they're white or yellow in color. So, when you're looking out. Okay? The faster you go, the farther out you have to look to maintain a position between markings that are present. Okay? It's sort of a subconscious skill that your peripheral vision does that. Okay? You do the same thing whether you're walking, or whether you're operating a motor vehicle. When you're walking down a hallway, okay, if you have an absence of peripheral vision, you're going to have problems orienting your environment to peripheral landmarks. Okay? In bioptic driving, low vision driver education training and assessment, one of the first things we emphasize is distance viewing skills. Looking out. Okay? The faster you go, the farther out you look, and keeping your eyes moving. Okay? Normally, I recommend with a novice driver that the side mirrors be positioned, okay, so that the inside part of the mirror is parallel to the side of the car. In contrast, some normally sighted drivers, as well as low vision drivers, may position that further out, so that they can tell when a car comes up into their blind spot. But remember, that if you find a student who is beginning to feel uncomfortable when things are alongside of them, they really shouldn't be looking to the left or the right. Okay? Now, while you're driving, you intermittently check behind you to see what's coming up on either side. Let's say you're on a three-lane interstate. Okay? And so, once they go past the point of the limited area that the inside mirror picks up, for a fraction of a second, depending upon their speed, okay, or their speed differential, you'll see them in the side mirrors. Now, you're able to attach, what we call blind spot mirrors, to the far left and to the far right. Now, that's a little bit more of a problem for a low vision driver, because, remember, any time you look in a blind spot mirror it's going to be cast further back. But the purpose is not to see something in 20/40 clarity, but only to tell that there's the presence of something. It could be an elephant. It could be a buffalo. You don't care. In fact, you don't need to know the color of something coming up that's in your side view mirrors. Okay? Or when you go to check your blind spot, which you should do every so many seconds. Your blind spot when you're driving, okay, at least in reference to your fields of view; let's say that you have a binocular field of view of 180 degrees. Okay? You have an inside mirror that picks up your lane, and parts of the adjacent lanes, further back. Side mirrors pick up the adjacent lanes. But then from the side mirror forward to that front 180 is your blind spots. Okay? When you check your blind spot, which means you keep your shoulders flush against the back of the seat and all you do is this. Okay? You don't turn at the hips like this, but you just turn your head. And when you do so, you're shifting your front 180 to here. Okay? When you see that, you're not using the scope. Bachofer: Right. Huss: Okay? You're not using that limited field of view, but you're using your full field of view. Okay? Remember that your peripheral field of view is responsible for picking up movement. And that's all you need to know, is the presence of something and where it's at, as it's coming up. Bachofer: Okay. That helps to explain those other skill sets that come in. It's not just the bioptic. Huss: Right. Bachofer: Yup. Students... also, often tell me that their parents are really nervous about this. "Mom and dad don't want me doing this driving." What can a... student be doing, as a passenger in the car, to help build that reassurance that they're able to use their vision to be a safe driver? Huss: Okay. Some of the things that parents can emphasize early on, Cindy, and in fact, I think are more important before they actually receive their first head-born distance low vision aid, is the following. And the reason for this is, remember that about 90 to 95% of the time, we all drive with our paracentral and peripheral fields of view, of which have acuity that falls below 20/400, all the way down to whatever lowest acuity is in our far right and far left. Okay? Things like "eye lead." And again, the best way to go over that is to visualize where you're driving. If you're driving at 15 to 20 miles an hour in a residential area where there's schools. Okay? Eye lead may be anywhere from 100 to maybe 200 yards down the roadway. Or let's say in a congested downtown area, whether it's a small business, a large metropolitan area, but where traffic is going at 20 to 25 miles an hour. It may be to the first, next traffic light, or to the second traffic light, and no further. Okay? But as the speed goes up, the farther out you have to look, for instance, on secondary highways; you may be looking down a quarter of a mile down the road. Okay? Or on interstate speeds at 60 to 70, two miles down the road. So, distance viewing skills is one of the first things that a parent can teach them. Where to look when you're driving. Okay? And the same thing applies when you're walking on two feet. Where to look. Okay? And the reason why you're going to do that is to avoid contact with critical objects, or conditions in your environment. Okay? Secondly, we're going to emphasize keeping your eyes moving, whether you're walking down a hallway, as a small child, or whether you're in a large metropolitan area, as an early teen, or whether you're, now, as a passenger-in-car with a parent. We're talking about keeping your eyes moving to the furthest extent left and right. Okay? If it's a residential area, we want to pick up that small child, as he exits the front door of one home, on one side, to take his toy across to the other side of the street. Okay? The same thing in a commercial area. We want to get that person carrying that ladder out of a hardware store, okay, and bringing it out to his pickup truck. Okay? We want to pick him up that soon. Okay? In a rural area, we want to be able to pick up a farmer, on his tractor, carrying a trailer of hay, okay, before he pulls out wide onto that narrow rural roadway. We want to pick it up in advance. Remember, there's only two things you can do in a car. And this is what you've got to teach your child, even as a passenger. You can modify your speed, and modify your lane position. Knowing where to look, how to look, keeping your eyes moving, and what to look for, you can teach them what's critical in a typical, dynamic driving environment. One is other road users. Anything on two or more feet. Okay? Anything on two or more wheels. Bicycles, motorcycles. Okay? Cars, trucks, tractors. Okay? Horses. Okay? Cows, okay, on the roadway. And then the third thing is, okay, beside well, let's go back to roadway characteristics. You can teach your child when they're looking far out, does the road continue straight ahead? Does it have a downhill? Does it have an uphill? Does it have a dip in the road. Is there a gradual curve, or a sharp curve, where I have to adjust my speed down? Okay? Those are called roadway characteristics. When you're turning onto a new road, and it's a divided roadway, is the child aware of what lane they're supposed to turn into, and that there is the presence of a medium, that may be surrounded by yellow lines, or no yellow lines? Contrast sensitivity, okay, is extremely important there. Okay? Contrast sensitivity simply refers to is, it's a measure of determining when that faded or washed out image, okay, becomes indistinguishable from its background. So, in the case where you turn from a side road to a main road, can that low vision child pick up that traffic island that divides lanes of traffic coming away from one another. Okay? So those things, knowing where to look, what to look for, how to look. Okay? And... if- if they emphasize teaching those things, before they place the device on their head. Okay? That's half the battle, because 90 to 95% of the time, they're going to be looking down here; looking out, looking wide, and being specific, what you have to react to. Okay? Adjustments in speed. Adjustments in lane position. Bachofer: And that's good. I think that you bring in that example of, say, contrast sensitivity, because you can do that in a grocery store. Huss: Yes. Bachofer: You can do that in the neighborhood. Huss: Absolutely. Bachofer: Wherever you're walking-- Huss: Yeah. Yeah. Yeah. Bachofer: in movement with your child. Checking that. Huss: I'll give you another example. Let's say that a parent is taking a walk with a small child, or let's say that, according to the IEP, the child is now doing some work with a mobility instructor outside. Contrast sensitivity can come to play when you're walking along, and there happens to be an elevated sidewalk slab, or a big chuckhole, or you're walking along an elevated... sidewalk. The same thing applies when you place that novice driver behind the wheel. For instance, as they're looking out, and from side to side, alright, let's suppose it's a relatively large chuckhole. And you know what happens when a car hits a chuckhole. Bachofer: [inaudible] Huss: Sometimes... you can't pick it up, because it may be full of water. But other times if you can avoid those, okay, it saves you a new tire, and a- an alignment. Okay? And usually front steering parts. Okay? So good contrast sensitivity is extremely important. Your field of view is extremely important. Can a monocular... candidate be successful in driving, with only vision in one eye? Yes, they can, but they have to have sufficient field in that good functional eye. Okay? We require, in West Virginia, that you have 120 degrees horizontally and 80 degrees vertically. Some states, it's much, much narrower. Okay? Ideally we would want a field of view out of both eyes to pick up movement. Bachofer: Right. Huss: Ok? Bachofer: I remember the reference that, for example, biking is a precursor to driving. Huss: Absolutely. Bachofer: Because if you're biking with your child, you're doing all that roadway prediction, considering how they're managing turns and obstacle avoidance... Huss: Yeah. And I'm glad you brought up bicycling. With cycling, okay, especially when a child has their training wheels taken off. They've got to learn they no longer look right down towards the pedals, but they have to look out, so they're not wobbling, okay, on their bicycle. Okay? And if you were ever to follow any type of driver, young or old, and they have short eye lead time. Okay? The driver that has, is fixating, or looking close to their car, you'll notice that they meander in lane. Sometimes ever so slightly. Okay? But you can pick it up. And it almost looks like you're following a driver that's under the influence. Bachofer: Hmm. Huss: . Okay? Bachofer: Students with low vision... are used to people underestimating how well they see, what they see, precisely. And I think finding that language for how you help-- you respond to friends, you refer-- respond to adults who ask, "How is that bioptic a good tool?," and that they're using their visual skills in conjunction with that. What can be some language that helps give those explanations? Huss: Okay. When you learned knowing where to look and how to look, there are some terms that differ in driver education, versus the results that you receive when you go to a low vision clinician, okay, to receive your bioptic. They're what we call awareness acuity, identification acuity, and sure acuity. Awareness acuity means when you look out there at that farthest point, or you keep your eyes moving, that you see something in contrast to its background, but you can't really define it and give it, a... name to it. Okay? From your visual memory. So that's called awareness. Difference between foreground and background. As you drive closer, if that object is moving, as it gets closer to you, at a certain period of time, within a reasonable degree of... good guessing, if you want to call it that, you'll say it's beginning to look like a vehicle. Okay? And then at a certain preferred distance, okay, you'll say, "I definitely know now it's a red Mustang." Okay? The same thing goes with your field of view. There's what we call static, dynamic, and preferred field of view. As a low vision driver, the first two usually tell you something about the potential extent of your field of view. Okay? With static visual field testing, you're stationary. You say what you can see at the upper point, the lower point, left and right, but you fixate on a point about 20 feet. With dynamic field, you're moving or walking, but you're still looking at a distance point, again showing the extent. With preferred field testing, you allow the individual to move their eyes anywhere possible, to find out do they overuse the right side, the left side, or are they good on both? In our particular program, as part of our screening process, even though we have the field test results of them clinically; what we do is take them out in a car, get them up on the middle lane of the interstate, and we advise them. We want you looking out there as far as you can, down the roadway, but we want you to use your peripheral vision as cars pass us on the left or right, some of which you'll be able to hear, or not hear, and as soon as you pick them up, just say left or right. Just those two words. And as they pass you, if they change their position on the roadway, then we want you to use more of your central vision to tell us whether they lane change, whether they used a signal or not. Okay? So some of these things parents can begin reinforcing with their child. Okay? You don't always need to use an optical system, and see it in clarity to detect and identify it. Okay? Remember, in driving there's only two things you can do as a driver. You can modify your speed up and down, using an accelerator, and/or a brake. Okay? And you've got a steering wheel, which allows you to adjust your position on the roadway. Okay? Let's say you have two lanes on the roadway, but there's a discarded part of a tire tread. And you don't want to run over a tire tread. Okay? So you may modify your lane position. Okay? But you don't need to see that tire tread, okay, in good clarity, to avoid it. Or let's say that something is discarded by a car coming the opposite way. Or a car is in an accident, and hits the retaining wall, dividing lanes of traffic on the interstate, and their tire flies off and it's bouncing, alright. And you're in adjacent lane. It's not your peripheral vision that's going to save you-- or pardon me, it's going to be your peripheral vision, and not your central vision, that saves you. Bachofer: Something you said brought up another question. I know with students who have a progressive vision loss, it's that, it's such a hard decision to know when I'm not safe, when it's time that I need to stop driving. Huss: Ok. Bachofer: What are things that they can-- kind of a checklist or that they need to be aware of? Huss: Individuals with progressive loss, in fact I'll use our state as an example. We are required by law, as long as the individual meets the visual requirements, in the law; we're required to allow them to be screened, trained, and tested. And if they pass the testing requirements, permit them to be licensed. But some of the things that you have to consider is this. Once your vision protocol, okay, is altered and it falls below that, required by law, to maintain that level of a special license, you're required by law to give up that driving privilege. Okay? Alright. And that's why a lot of states have annual vision re-examinations. In the case of a progressive visual impairment, when it's known before a license is given, sometimes they'll require that they have a vision test every six months. But from a functional standpoint, that's an excellent question, Cindy. From a functional standpoint, you can begin to look at things that a person with progressive loss, begins to have problems with. One is lane maintenance. Okay? Another may be in the execution of a left-hand turn. And that's one thing that, a lot of times, I'll use. If you're unable to safely, confidently, and independently execute a left-hand turn, without assistance, if you can't do it any longer, it's time to give up the keys. Bachofer: And I think it's listening to that confidence inside of your head. Huss: Yes. Bachofer: Not just relying on those measurements. Huss: Yes, yup. The important point to remember is about 90 to 95% of our decisions are made from our paracentral and peripheral fields of view. Okay? We only use our central three to five degrees, which is responsible for our good clarity of vision, etceteras, okay, a small percentage of the time. And when we do that, only for fractions of a second. We do-- whether we do that with a normally functioning eye and visual system, or whether we do that with a bioptic lens system that has a miniature telescope that's serving as a pseudo fovea, what I like to call it sometimes, okay, which takes a little bit longer to process. Okay? But still within the safe parameters for safe driving. Okay? So, if sufficient peripheral vision is impaired-- remember, if the individual is, let's say, let's say they're using good eye lead time but, let's say that they're not eye scanning. Okay? Look at the problems they could get into, if you have a flagman in the middle of the road. Okay? And that person is looking down the road, but that restricted field of view doesn't allow you to pick them up. Okay? One of two things happens. Okay? Either you don't perceive it and you run over the guy. Or the guy jumps out of the way. . Okay? Bachofer: Yeah. Huss: When that becomes apparent, it's an absolute that the person has to give up driving. The... inability to pick up the correct... position on the roadway, when you go through an intersection, is another. For instance, I've had an opportunity to assess the driving performance of individuals with retinitis pigmentosa that is advanced. Okay? In most instances with retinitis pigmentosa, the field part of the impairment begins mid periphery and goes out and comes in. But when it becomes advanced, when it's down to less than 10 degrees, any time you progress in speed over 20 miles an hour, in order to maintain a straight line, the person has to keep looking down the roadway. And lateral scanning becomes reduced. And that's where you notice when drivers approach, let's say a plus-shaped intersection. Sometimes, they don't realize that they have to stop until they're past that go versus no-go standpoint. Okay? Or there's a curve in the road, and they don't see the curve in the road, until the last minute. Okay? So fields of view have a lot to do with progressive eye conditions. Likewise, the presence of large, whether it's centralized, or off center, scotomas. The bigger the scotoma, the denser the scotoma, the more problems you're going to have, even if you attempt to use a bioptic. Okay? And it's begin-- again, because 90 to 95% of the time you're not going to be dipping down into the telescope. Bachofer: You've been able to... work with us for several years now. I've seen-- heard the comments from students-- and what would be any last comments you want to make for them, on that awareness of making this decision to be a driver. Huss: I think that... if a child is of the age where there's an interest, there's an incentive-- I like to afford any individual, okay, when they become of licensing age, the opportunity to explore driving. Okay? To explore it. They may not be successful. Okay? But they should have the opportunity, just like their sighted peers, to go through a... period of driver education training. Some, and it's usually decided upon on their own, they decide after two or three weeks, this is still too anxiety producing for me, and I think I have to go back, and, along with my parents, observe the actions of other drivers for six to 12 months, and then come back. That happens with people in their 20s, and their 30s, and their 40s, and in their 50s, as well. Just not young children. Okay? But it can occur with novice drivers. Okay? So, I think the decision to explore the driving privilege has to be one that's personal. [ Music ] [Silence] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. Fade to black.